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The 113th Congress Should Reauthorize or Extend the Ryan White Care Act

Turning the Tide Together was the theme of the International AIDS Conference in Washington DC in July 2012. The key message from AIDS 2012 was that ending the HIV epidemic is with reach, but only if we are able to scale-up and focus our resources and efforts effectively. Access to treatment and care is vitally important and the full implementation of the health reform law passed in 2010, the Patient Protection and Affordable Care Act (ACA), will provide vitally important and much needed services. However, it will not eliminate the need for the Ryan White Care Act.

The Ryan White Care Act is a federal program designed specifically for the care and treatment and support programs for people with HIV/AIDS in the United States. is a “payer of last resort” program and provides coverage, care, and treatment, for those who have no other source of coverage or face coverage limits. The program has been reauthorized four times since it was first enacted by Congress in 1990. The third largest source of federal funding for HIV care (after Medicare and Medicaid), Ryan White reaches more than 500,000 people each year. It is subject to Congressional appropriations and some states and localities also provide funding to their Ryan White services. The Ryan White Care Act is due to be reauthorized in 2013, but it also possible for Congress to extend the program because the sunset clause was removed when it was last reauthorized (2009).

Starting in 2014 thousands of Ryan White patients who previously received care and treatment through the Ryan White program will begin to receive coverage through other programs created under the ACA. A majority will become part of the new Medicaid expansion; another portion is likely to gain coverage through the State Insurance Exchanges and the new state Pre-Existing Condition Plans (PCIPs).

Most of the provisions of the ACA do not take effect until 2014, and their overall effects of ACA implementation will not become clear until sometime after that. Because Ryan White is a “payer of last resort” program, those patients who will have access to the new programs must use them first. However, since the states will have significant flexibility in establishing the new programs, some former Ryan White patients will end up with insufficient benefits, inadequate access to medications, or possibly even less than adequate access to care. They may also see new or increased co-pays, deductibles, or other cost-sharing that is outside their ability to pay. This means that Ryan White will need to be their safety net after 2014. Ryan White will need to be modified so that it effectively wraps around the ACA and all patients are able to access the services they need.